Sam Sun Young Ahn, PHARMD
Individual provider Active NPI Pharmacist · Normal, IL
NPI 1508470873 · NPPES record last updated Sep 3, 2020
Key facts
- NPI
- 1508470873
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051.296489 (IL)
- Practice address
- 1502 Fort Jesse Rd
Normal, IL 61761-1980 - Phone
- (309) 862-4156
- NPI assigned
- Sep 3, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051.296489 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.296489 | IL | Yes |
Addresses
Primary practice location
1502 Fort Jesse Rd
Normal, IL 61761-1980
Mailing address
1502 Fort Jesse Rd
Normal, IL 61761-1980
Phone (309) 862-4156
Other providers in Normal, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.